Anaesthetic Management of Patients Undergoing Lung Volume Reduction Surgery for Treatment of Severe Emphysema

Abstract

Lung volume reduction surgery can improve lung function in patients with emphysema. We report our anaesthetic experience, problems and the physiological data of eight patients. Our aims were prevention of air trapping and air leaks, good analgesia and early recovery and mobilization. We were able to achieve these aims using pressure limited ventilation, lumbar epidural diamorphine, propofol infusions and intensive physiotherapy. Hypoxia during one-lung ventilation was the main intraoperative problem. Air leaks, infection and pulmonary hypertension were the main postoperative problems.

Anaesthesia for Lung Volume Reduction Surgery

“…Some have argued that the use of lumbar epidural analgesia with diamorphine reduced the requirement for vasopressor agents during the procedure and avoided the risk of impaired intercostal muscle function postoperatively. 16 However, it has been shown that 0.25% bupivacaine does not significantly impair respiratory function 17 , and our preference is to use this option intraoperatively, and a continuous infusion of 0.1% bupivacaine and fentanyl 1-2µg/mL postoperatively. Accordingly, it is our standard practice to place a thoracic epidural catheter, usually in the T 5-6 interspace, and to establish a working block prior to the induction of anaesthesia.…”

Anaesthesia for lung volume reduction surgery

“…They also demonstrated that the magnitude of the change in right ventricular stroke volume and right ventricular ejection fraction from rest to exercise increased after LVRS, and that the size of this change correlated with the change in residual volume to total lung capacity ratio. Liu et al ., in a series of eight patients, demonstrated a significant increase in both cardiac index and stroke volume after surgery [16]. Two of these patients underwent transoesophageal echocardiography peri‐operatively.…”

“…Intermittent re‐inflation of the lung is sometimes necessary during the course of surgery in order to improve oxygenation. This can help to reconfirm the target areas, as well as providing the surgeon with a guide to how much more lung needs to be resected [16].…”

“…When performing bilateral surgery, consensus opinion is to operate on the worst lung first [2, 16, 21] in order to improve its function before exposing it to one‐lung ventilation.…”

“…Most authors avoid sedative premedication in order to avoid respiratory depression in this already critically compromised group of patients [16, 30]. However, Triantafillou states that most of his patients were lightly premedicated with morphine and/or a benzodiazepine [21].…”